Higher health costs can hurt your well-being, study suggests

Expensive care causing some to forgo food, drugs

Oct. 19, 2013

Written by

Shelley DuBois

The Tennessean

The cost of health care can be just as toxic for a patient as the side effects of their medication, suggests a new article published this week in the New England Journal of Medicine.

The piece, co-authored by a team of researchers at Duke University, examines how expensive treatments can negatively affect patients’ well-being, and suggests that physicians should incorporate cost into conversations with patients.

The study touches on one aspect of the major shift in thinking in the country’s health care system. Currently, this country’s health system rewards volume over quality of care, which is an issue that the Affordable Care Act aims to address. Cost of care, according to the NEJM paper, is part of the quality equation.

The paper cites a 2011 study from the Centers for Disease Control and Prevention that claims one-third of Americans at the time were either struggling to pay medical bills or defaulting on payments. That financial distress had real effects on national health, as people cut back on buying food, or skipped out on vital medication, the article said.

Doctors used to consider cost, before insurance got in the way, said Peter Ubel, a professor of marketing and public policy at Duke’s Fuqua School of Business and one of the study’s co-authors.

“Before insurance, in the middle of the 20th century, doctors talked about fees,” Ubel said. “They often bartered instead of having money or informally adjusted fees depending on people’s ability to pay. But once insurance got in there and people were protected from the cost, there was no need to discuss it anymore.”

Some physicians do have these difficult conversations with patients. They tend to work with low-income populations, Ubel said. These physicians are already sensitive to the fact that the cost of care affects patients’ quality of life, their prognosis or, simply, their happiness.

But for the most part, neither physicians nor patients are prepared to have these kinds of discussions, especially during end-of-life care. Doctors will do everything they can to save patients, Ubel said. “They just think, ‘Hey, full court press, all systems go,’ without considering the cost.” The idea that someone has the right to choose cheaper care that might not provide what doctors consider the absolute best medical outcome does not sit well with us as a nation.

But given the toxic effects of high-cost care, the paper suggests, it’s an idea that Americans will have to consider.

For more on the national shift to quality-of-care, read Sunday’s Tennessean to learn how the Affordable Care Act will affect hospitals.